Payable Services

(A) Comprehensive Evaluation. Payment for a comprehensive evaluation includes the preparation of a written report for the member's medical record that contains at least the following information: (1) the member's name and address; (2) the name of the referring licensed physician or licensed nurse practitioner; (3) a detailed treatment plan prescribing the type, amount, frequency, and duration of the therapy and indicating the diagnosis, anticipated goals, and location where therapy will take place, or the reason treatment is not indicated; (4) a description of any conferences with the member, the member’s family, the member’s clinician, or other interested persons; (5) other health-care evaluations, as indicated; (6) a description of the member's psychosocial and health status that includes: (a) the present effects of the disability on the member and his or her family; (b) a brief history, the date of onset, and any past treatment of the disability; (c) the member's level of functioning, both current and before onset of the disability, if applicable; and (d) any other significant physical or mental disability that may affect therapy; (7) assessment of articulation, stimulability, voice, fluency, and receptive and expressive language; (8) documentation of the member's cognitive functioning; (9) a description of the member's communication needs and motivation for treatment; (10) the therapist's signature and the date of the evaluation; and (11) the prognosis. (B) Group Therapy. The MassHealth agency pays for therapy provided to a member in a group consisting of more than two but less than seven persons, subject to the restrictions and limitations of 130 CMR 413.000. (C) Complete Audiological Evaluation. The MassHealth agency pays for a complete audiological evaluation only if it is prescribed by a licensed physician or licensed nurse practitioner in writing, subject to the restrictions and limitations of 130 CMR 413.000. (D) Earmold. An earmold is not payable if it is included in the manufacturer's price of the hearing aid or if the member already has an appropriate earmold. Payment for an earmold includes the following: (1) the ear impression; (2) the proper fitting of the earmold; and (3) any adjustments that may be needed during the operational life of the earmold. (E) Ear Impression. Payment for an ear impression includes one properly formed ear impression for each in-the-ear hearing aid purchased and is allowed only at the time of purchase of the hearing aid.